The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, SAR.
J Pain Symptom Manage. 2011 Feb;41(2):347-57. doi: 10.1016/j.jpainsymman.2010.04.024. Epub 2010 Dec 4.
Breathlessness, fatigue, and anxiety are distressing symptoms for patients with advanced lung cancer. Usually managed as isolated symptoms, they often can occur simultaneously. Previous research often has addressed management of discrete symptoms rather than considering them as a cluster, which, in reality, is the situation faced by patients.
This study aimed to examine the effectiveness of a psychoeducational intervention (PEI) on the symptom cluster of anxiety, breathlessness, and fatigue, compared with usual care.
A pretest/post-test, two-group, randomized, controlled trial was conducted. Education on symptom management and coaching in the use of progressive muscle relaxation were delivered to patients one week prior to commencing radiotherapy (RT), and repeated three weeks after beginning RT. Symptom data were collected at four time points: prior to the intervention, three weeks, six weeks, and 12 weeks postintervention.
One hundred forty lung cancer patients receiving palliative RT were recruited from a publicly funded hospital in Hong Kong. Doubly multivariate analysis of variance revealed a significant difference (time×group interaction effect, P=0.003) over time between the PEI and usual care control group on the pattern of change of the symptom cluster. Significant effects on the patterns of changes in breathlessness (P=0.002), fatigue (P=0.011), anxiety (P=0.001), and functional ability (P=0.000) also were found.
PEI is a promising treatment for relieving the symptom cluster and each of the individually assessed symptoms. More effort needs to be directed at studying impact of interventions on common symptom clusters.
呼吸困难、疲劳和焦虑是晚期肺癌患者的痛苦症状。这些症状通常被视为孤立的症状进行管理，但实际上它们常常同时出现。之前的研究通常侧重于管理离散的症状，而不是将它们视为一个集群，而实际上患者面临的是这种情况。
本研究旨在比较心理教育干预（PEI）与常规护理对焦虑、呼吸困难和疲劳症状群的疗效。
采用了预测试/后测试、两组、随机、对照试验。在开始放射治疗（RT）前一周向患者提供症状管理教育，并在开始 RT 后三周重复，同时还教授了渐进性肌肉松弛的使用方法。在四个时间点收集症状数据：干预前、治疗 3 周、6 周和干预后 12 周。
本研究共招募了 140 名在香港公立医院接受姑息性 RT 的肺癌患者。双变量方差分析显示，PEI 组与常规护理对照组在症状群变化模式上存在显著差异（时间×组间交互作用，P=0.003）。呼吸困难（P=0.002）、疲劳（P=0.011）、焦虑（P=0.001）和功能能力（P=0.000）的变化模式也有显著影响。
PEI 是缓解症状群和单独评估症状的有前途的治疗方法。需要更多的努力来研究干预措施对常见症状群的影响。
